Fear of injecting to much insulin

[Pota]

I have for a long time been affraid of injecting to much insulin.
A couple of years ago i was never affraid. I took alot of insulin, went out without my Freestyle, and had no fear..
But then it all started. I began to reduce my insulin levels more and more... Affraid of getting hypos.
I usualy go for 3-4IE for most of my meals... Sometimes bellow... If i eat 3 potatoes i take 3 IE... if i take 8 potatoes i take 4IE, tho i know i should be taking more, im just sooo affraid of seeing insulin numbers above 4. Im so affraid because im affraid to vommit because i get anxtious, and then get low since i vomit out everything ive eaten :S

If i have a meal which I injects 3 IE and 2 hours later im back to normal i think... "omg, what would have happend if i injected 5 IE, would i be able to stop it before its too late?

Should be noted that im very active so im very sensitive.

What could be done to overcome this fear... People tell me that: "you shouldent be affraid... Even if you doubled your dose from 3 to 6... you would be able to stop it when you get low... Even when its dropping quickly"
What do you guys say? Do you agree? Anything i could do to overcome this fear?

 

[jack412]

baby steps, one at a time and before you know it, your home
fears aren't rational but they feel like it
with a pocket full of glucose jelly beans as backup, I think you could do another unit.
if you are afraid of vomit, get an emergency glucose injection pen or whatever they call them, to jab yourself with.

 

[Pota]

Does those glucose pens works even when ive taken 5-6 units and has vomited? Remember im sensitive

 

[jack412]

tell how many carbs is for 6 units?
seems you can adjust the shot with this type
http://en.wikipedia.org/wiki/Glucagon_rescue

 

[Pota]

I would guess around 150.

 

[AndyS]

One thing to be aware of with the Glucagon pens is that they rely on your liver functioning correctly. They are NOT glucose shots, they are a hormone that tells your liver to dump sugar.

If you have had a few drinks these Glucagon pens will typically NOT work, or at least not work as well.

I felt this is something important to be aware of.

With that health warning over with.
Pota, I know where you are coming from. I get this fear too myself from time to time. The best thing I have found to help with that is to:
1) Make sure everyone I am likely to be around knows the condition, the signs to look for and what to do if I do drop
2) Make sure I have some hypo remedy (Lucozade sweets for me) pretty much everywhere so I can treat myself quickly
3) When I am going through the times when my mind is not working quite right I keep a very careful log of everything and calculate my doses twice. (Measure twice, cut once and such)

I have made the stupid mistake of picking up the wrong pen and injecting my evening levemir dose but in novorapid, fortunately I noticed as I cleaned up and went and stuffed my face with food to cover it.

Do you have issues with hypo awareness? If you have lost your hypo awareness and you are having serious anxiety about overdosing your insulin (which it sounds like you are) speak to your Dr and see about getting CGM (Continuous Glucose Monitor) since most of them these days can be configured with an alarm that will go off when your BG drops too low or is falling especially fast.

If you are having trouble keeping solids down after injecting then it may be worth looking at some of the gel based glucose supplies. These can be either squirted under your tongue or rubbed on your gums to absorb that way. It's a little more awkward but it can work fairly quickly too.

Best of luck.

/A

 

[Wurst]

Low carb low doses, simple.

 

[Pota]

Hmmm I see Andy, but im thinking for myself... I inject pretty low doses.. 3-6IE.. I mean, does doses like this become seriously dangerous? Or is this just a fear im having problem with?
Low carb low doses dosent work for me, since im an elite athlete and need alot of carbos.

 

[AndyS]

Hi Pota,

A dose of 3-6 could be high or low. It depends on what your sensitivity to insulin is.
For me I have found that the insulin to cover carbs is very dependent on time of day and a few other factors.
For example in the evening if I had a meal of say 50g Carb then I would need 10units.

Unfortunately your question is not an easy thing to answer since we are all different.
Perhaps what you need to do is get an understanding of what 1Unit does to your BG levels and also what amount of insulin you need to cover your food intake. The only way to do this is to test a lot and keep a careful diary of things and work from there.

In the interim try and find a fast acting carbohydrate that you are comfortable with and can handle and keep it handy for when you do start to feel a hypo coming on.

Fear of hypos is completely natural and understandable and I think we all go through it at some point to a greater or lesser degree. Hypos suck and they make you feel horrible afterwards so it's no surprise that we all dread them.
The thing is to find what works for you to treat them, at that point I think you may find your anxiety issues will lessen a bit.

Try discussing it with your Dr, Specialist of Diabetic Specialist Nurse and see what they can do to help you with it.

 

[phoenix]

Glugagen hypo kits are normally used by someone else to help you when you can't take oral glucose .
If you are very insulin sensitive then maybe you would be better off using a half unit pen. This would mean you could give 3.5u rather than 3 or 4units.
Keep good records, make certain of the carb count by weighing things like potatoes It will help show you if you are under dosing. If you are then you can move slowly towards an appropriate dose.
Re managing diabetes and sports have a look at the runsweet site, knowing when you are likely to hypo and how to help to prevent them may help.
Lastly here's a blog from a clinical psychologist who works with people with diabetes. This page is about fear of hypos but there are other articles that might be useful http://positivediabetes.com/blog/?p=202

 

[jack412]

thanks Andy, the wiki said about the liver release but didn't say about alcohol, what's the treatment when on a night on the booze, you can't hold anything down and just throwing up?

 

[AndyS]

Paramedic with a glucose drip I guess.

Luckily I have never needed either.

 

[AlexMBrennan]

Glucagon kits are for when you are unconscious and unable to swallow, otherwise sugary drink (e.g. Lucozade) is preferable - in particular due to glucagon shots being hardly a nice experience (they tend to cause nausea and vomiting for example).
If you are afraid you'll be sick, wait a bit until you are sure you can keep the food down before you inject insulin.

 

[AndyS]

If you are afraid you'll be sick, wait a bit until you are sure you can keep the food down before you inject insulin.

That would be an excellent piece of advice right there.
I've shot myself in the foot previously by injecting before I eat and then losing my appetite part way through the meal. I always inject afterwards now.

When feeling sick it seems the most sensible thing to do.

 

[yingtong]

What is insulin to carb ratio?


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[noblehead]

Not sure what the relevance was with regards to the Glucagen kit to the opening post

However both Andy and Phoenix have given some good advice on how to cope with the fear of going hypo after injecting, all I can add Pota is to discuss your concerns with your consultant and explain your anxiety problems with regards to injecting insulin, before you do keep a detailed account of your insulin doses, bg readings, food and exercise regime. Good luck!

 

[Spiker]

Hi @Pota

A lot of good advice here. You are right that vomiting is problematic. Carrying a glucagon kit may be a useful backup for you. Another trick if you are vomiting is to pass a glucose-rich liquid into your mouth and gums without swallowing, or before swallowing. Swill the liquid around your gums and saliva glands. Some of the glucose will pass directly into your bloodstream, bypassing some or all of the digestive process.

If the various suggestions don't help you to try then you may need to get professional help for an anxiety disorder. The fear of injecting is a much bigger risk to your health than the risk of hypos.

Are you an endurance athlete? Unless you are long distance runner who has just completed a serious race, you will always have enough glycogen to recover from a hypo by yourself. The fear of death by insulin overdose is completely unreasonable. Even murderers who try to kill people with insulin on purpose find it is really, really hard to do.

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[Pota]

Hi @Pota

A lot of good advice here. You are right that vomiting is problematic. Carrying a glucagon kit may be a useful backup for you. Another trick if you are vomiting is to pass a glucose-rich liquid into your mouth and gums without swallowing, or before swallowing. Swill the liquid around your gums and saliva glands. Some of the glucose will pass directly into your bloodstream, bypassing some or all of the digestive process.

If the various suggestions don't help you to try then you may need to get professional help for an anxiety disorder. The fear of injecting is a much bigger risk to your health than the risk of hypos.

Are you an endurance athlete? Unless you are long distance runner who has just completed a serious race, you will always have enough glycogen to recover from a hypo by yourself. The fear of death by insulin overdose is completely unreasonable. Even murderers who try to kill people with insulin on purpose find it is really, really hard to do.

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Thanks alot all!

And thanks alot Spiker... You hit me the right way with telling me that even murder attemp with insulin is hard, lol, that made me feel better, cause im injecting small doses compared to that I wouldent believe a murderer would inject someone with 5 -8 units hehe

I have heard about putting gel in the mouth, but i dident think it was that effective, it is you say? Is it as effective as swallowing?

Yesterday i ate some potatoes and fish... I started at 6.4 BG and injected 4 units.. After 1,5 hour i was @ 11.9.. I then took another unit and went down to 9.8 after 1 hour... I then injected 1 more unit.. and after an hour i went to the shower and when i came back out I did a BG check.. about 1,5 after the last injection... I then had 3.7 BG... I took some Soda and it keept on going down to 3,2 (took more soda) then 2.7 (took more soda) then 2.5 (took more soda) before it stopped. It took about 40min for it to rise to 3.5... Is this EXTREMLY special or could this be normal?

 

[AndyS]

Hi Pota,

One thing you need to bear in mind is that most insulin analogs tend to remain effective to some degree for around 5 hours.
If you are putting small doses on top of each other at relatively short intervals you can get something called "stacking" occurring where all the small amounts in your system build up against each other and result in much higher amounts of active insulin in your system in the short term.

Doing a correction as soon as 1.5 hours after eating is a bit too soon.
It sounds almost like you are chasing your sugars which is where you may be coming up with problems.

Unless you are sick and therefore following sick day rules the best rule of thumb the rest of the time is:
Test before a meal, if your levels are high then add the correction onto the inulin you give for the meal.
If you test after a meal, wait at least 2 hours, even then if your levels are only a little bight high give it a couple more hours or test at the next meal.

Keep a log of the above, if you consistently find, for example, that your levels are good at lunch, then before dinner they are high and you consistently have to add a correction then you need to look at your Carb to Insulin ratio at lunch.
I find that I aim to have a good BG just before each meal and before I go to bed.
I only correct for high either when I am having a meal or I'm heading to bed and my sugars are especially high.

Hope that helps you a little.

 

[Pota]

Hi Pota,

One thing you need to bear in mind is that most insulin analogs tend to remain effective to some degree for around 5 hours.
If you are putting small doses on top of each other at relatively short intervals you can get something called "stacking" occurring where all the small amounts in your system build up against each other and result in much higher amounts of active insulin in your system in the short term.

Doing a correction as soon as 1.5 hours after eating is a bit too soon.
It sounds almost like you are chasing your sugars which is where you may be coming up with problems.

Unless you are sick and therefore following sick day rules the best rule of thumb the rest of the time is:
Test before a meal, if your levels are high then add the correction onto the inulin you give for the meal.
If you test after a meal, wait at least 2 hours, even then if your levels are only a little bight high give it a couple more hours or test at the next meal.

Keep a log of the above, if you consistently find, for example, that your levels are good at lunch, then before dinner they are high and you consistently have to add a correction then you need to look at your Carb to Insulin ratio at lunch.
I find that I aim to have a good BG just before each meal and before I go to bed.
I only correct for high either when I am having a meal or I'm heading to bed and my sugars are especially high.

Hope that helps you a little.

Are you saying that for example if im injecting 4IE to a meal... can be less hard to stop if i go low, than example injecting 2IE on the same meal... and 2 after 1 hour..(totalt 4 IE)?